CMS finalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage

CMS NEWS

CMS finalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage

Today, the Centers for Medicare & Medicaid Services (CMS) finalized updates that will take significant steps in continuing the Trump administration’s efforts to increase competition among Medicare Advantage and Part D plans so patients get higher quality care at lower costs. These changes will increase plan choices and benefits, and include important actions to address the opioid crisis.

“Today’s changes give plans the ability to be innovative and offering benefits and services that address social determinants of health for people with chronic disease,” said CMS Administrator Seema Verma. “With Medicare Advantage enrollment at an all-time high, plans need greater flexibility in offering benefits that they focus on preventing disease and keeping people healthy.”

The final policies will further expand opportunities for seniors to choose Medicare Advantage plans that are providing new supplemental benefits tailored to their specific needs. Last year, CMS empowered patients through expanding the definition of health related supplemental benefits that Medicare Advantage plans could offer to enrollees, where the primary purpose of the benefits are daily maintenance of health. Beginning in 2019, Medicare Advantage plans can now offer supplemental benefits that are not covered under Medicare Parts A or B, if they diagnose, compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization. For example, plans may offer adult day health services, and/or in-home support services under the expanded definition of supplemental benefits when they meet these standards.

For 2020, today’s announcement gives chronically ill patients with Medicare Advantage the possibility of accessing a broader range of supplemental benefits that are not necessarily health-related but have a reasonable expectation of improving or maintaining the health or overall function of the enrollees. These benefits can address social determinants of health for beneficiaries with chronic disease. For example, beneficiaries enrolled in a Medicare Advantage plan could now receive meal delivery in more circumstances, transportation for non-medical needs like grocery shopping, and home environment services in order to improve their health or overall function as it relates to their chronic illness. For a patient with asthma, for example, a Medicare Advantage plan could cover home air cleaners and carpet shampooing to reduce irritants that may trigger asthma attacks. For someone with heart disease, a plan could provide heart healthy food or produce. And for someone with diabetes, a plan could provide transportation to a doctor’s appointment, diabetes education program or to see a nutritionist.

In addition to expanding opportunities for choice and providing flexibility in offering supplemental benefits, these payment and policy updates include actions that help combat the nation’s opioid crisis. In today’s announcement, CMS encourages Medicare Advantage plans to take advantage of new flexibilities to offer targeted supplemental benefits, cost sharing reductions for patients with chronic pain or undergoing addiction treatment, and encouraging Part D plans to provide at least one opioid-reversal agent on a lower cost-sharing tier. CMS’ overutilization policies have resulted in a 14 percent decrease in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3 percent to 31.3 percent), with the largest decrease from 2016 to 2017 (5 percent).

Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction ratings. Average Medicare Advantage premiums are at their lowest in six years, Part D premiums are at their lowest in three years, and plan choices have increased. Today’s announcement builds in additional flexibilities that will continue to increase choice and competition among Medicare health and drug plans.